Despite decades of research, the question of developmental anesthetic neurotoxicity remains unsettled and continues to divide the medical community and beyond. Several studies have evaluated single or brief anesthetic exposures in relatively healthy children. In these studies, single exposures have been associated with negligible to no differences in the neurodevelopmental domain of cognition/full-scale intelligence quotient, and relatively small effect sizes in other domains such as behavior and executive function. The findings from these investigations, however, do not allow us to ascertain associations after longer anesthetic exposures, or in children with more complex medical conditions requiring major surgical procedures. Indeed, whether long(er) anesthetic exposures affect brain development is a biologically relevant concern since consistent preclinical data indicate dose- and exposure time–dependent drug effects. Evaluations in children with complex medical conditions are also of concern as these children may be more vulnerable to the effects of neurotoxins. There is a consensus...

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